T, (Level of Evidence: C) 2. Compared with CCTA, specificity and PPV were significantly in favor of SPECT (specificity, 94%; P < .001; and PPV, 88%; P = .01) and PET protocols (specificity, 84%; and PPV, 81%; P < .001). Furthermore, a combined anatomical and functional assessment does not add incremental diagnostic value but guides clinical decision-making in an unsalutary fashion. Naturally, CCTA will be closely associated with ICA and, as such, will yield high accuracy. Diagnostic performance of cardiac imaging methods to diagnose ischaemia-causing coronary artery disease when directly compared with fractional flow reserve as a reference standard: a meta-analysis. Obtained funding: Lammertsma, van Rossum, Knaapen. Objectives The purpose of this study was to investigate whether fractional flow reserve (FFR) should be performed for patients with coronary artery disease (CAD) to guide the percutaneous coronary intervention (PCI) strategy. (Level of Evidence: C) 3. The radiation dose for SPECT was significantly higher compared with that for CCTA and PET (both P < .001). Cardiac catheterisation is an invasive diagnostic procedure that provides important information about the structure and function of the heart. Di Carli Diagnostic Performance of CCTA, SPECT, PET, and Hybrid Cardiac Imaging for Diagnosis of Ischemia-Causing Coronary Artery Disease as Indicated by Fractional Flow Reserve. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2017;2(10):1100-1107. doi:10.1001/jamacardio.2017.2471, What are the diagnostic performances of coronary computed tomography angiography, single-photon emission tomography, [. SD, Blankenship Diagnostic Performance of Coronary Computed Tomography Angiography, Single-Photon Emission Computed Tomography, and Positron Emission Tomography Imaging for Diagnosis of Significant Coronary Artery Disease as Defined by Different Standards, Figure 3. During the procedure a long, thin, flexible tube called a catheter is inserted into a blood vessel in your groin or arm. V, Kero To allow for a hybrid interpretation, fusion images of CCTA with SPECT or PET were generated to allocate coronary arteries to their subtended vascular territories. FFR indicates fractional flow reserve; ICA, invasive coronary angiography; NPV, negative predictive value; and PPV, positive predictive value. No other disclosures were reported. Clinical value of absolute quantification of myocardial perfusion with. Next review due: 03 December 2021, to plan interventional or surgical procedures – such as a, being allergic to the contrast dye – this is uncommon, but you should discuss any, bleeding under the skin where the catheter was inserted – this should stop after a few days, but you should contact your GP if you're concerned about it. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. J, Twisk We aimed to assess the adherence … Hybrid imaging using quantitative H. Tonino It involves a procedure called catheterisation. C, D, Giorgetti CAC indicates coronary artery calcium; CCTA, coronary computed tomography angiography; LD-CT, low-dose computed tomography; PET, positron emission tomography; and SPECT, single-photon emission computed tomography. Background: Fractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) datasets (FFR CT) has emerged as a promising noninvasive test to assess hemodynamic severity of coronary artery disease (CAD), but has not yet been compared with traditional functional imaging. How would you follow up on the negative imaging result? Furthermore, the combination of anatomical and functional assessments configuring a hybrid approach may yield improved accuracy. Get free access to newly published articles. Among the 615 vessels analyzed, 160 (26.0%) contained hemodynamically significant stenosis (eFigure 3 in the Supplement). BL, Leipsic The absolute difference in specificity between SPECT and PET was 9.6% (95% CI, 1.6%-17.7%) in favor of SPECT, whereas the absolute difference in sensitivity was found to be 30.4% (95% CI, 20.9%-39.9%) in favor of PET. YE, Furthermore, we used [15O]H2O as a tracer agent for PET with solely quantitative flow analysis for the diagnosis of myocardial ischemia because this has proven superior over qualitative image analysis.27 This result has only been demonstrated, however, for this particular tracer, and these results may not be extrapolated to the more commonly used tracers [13N] ammonia and rubidium 82 in which visual grading and quantitative flow interpretation are often combined for diagnostic purposes. Statistical analysis: Danad, Driessen, Stuijfzand, Heymans, van de Ven, Knaapen. PS, Hoffmann I, Uusitalo The study protocol was approved by the Medical Ethics Committee of the VU University Medical Center and all participants provided written informed consent. However, others have argued for CT as an initial diagnostic test, maintaining the importance of ruling out CAD by CT and assessing the presence of functionally irrelevant coronary atherosclerosis, which may harbor important prognostic information, as the foremost information to be garnered from the study. angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. Positron emission tomography was associated with a significantly lower radiation dose than was CCTA (P < .001). Prior studies are in support of the latter, although FFR-comparison SPECT studies evaluating imaging with or without attenuation artifacts have not been performed to date.23,24. variations in use of coronary angiography in the United States have led to concerns about its appropriateness. The addition of either SPECT or PET to CCTA improved the specificity compared with CCTA (SPECT, 97%; and PET, 91%; P < .001) but lowered the sensitivity from 90% to 50% when SPECT was added to CCTA and decreased to 74% for hybrid PET/CCTA (P < .001). a very small risk of more serious complications, including damage to the artery in the arm or leg where the catheter was inserted. Furthermore, the combination of anatomical and functional assessments configuring a hybrid approach may yield improved accuracy. Read it out to me. For LAD and LAD/diagonal bifurcation visualization the cranial views are most useful. Results This study possesses the following unique design features: CCTA, SPECT, and PET were compared prospectively in a true head-to-head fashion; invasive FFR of all coronary arteries, irrespective of the imaging findings, was used as the reference standard; latest-generation techniques—such as CT-based attenuation correction in SPECT perfusion imaging—were used; and all scans were analyzed by core laboratory experts (8 of us: J.L., R.R., C.N., J.K., M.M., R.S.U., J.K.M., and K.E.) You should seek immediate medical attention if swelling at the site of your wound gets worse, or if you experience excessive bleeding or circulation problems in your limbs. et al. On PET scans, myocardial segments with a hyperemic myocardial blood flow of 2.30 mL/min/g or less were considered to be abnormal. JAMA Cardiol. Dr Lammertsma reported receiving research grants from AVID, Philips Healthcare, F. Hoffmann–La Roche Ltd, and the European Commission. The aim of this study is to assess the efficacy and safety of this strategy by comparing the results in 2 groups of patients: in group 1 (179 patients), PTCA was performed at the time of initial coronary angiography and in group 2 (549 patients) PTCA was performed, 15 to 30 days after initial coronary angiography. The mean (SD) diameter stenosis of atherosclerotic plaques causing ischemia was 60% (18%). Similar trends have been observed on a per-vessel basis (eAppendix in the Supplement). BA, Dowsley Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. et al. ; You have aortic stenosis or another valve problem. Blockages can lead to angina or a heart attack. A, Gimelli Scans were additionally quantitatively reported with the use of the total perfusion defect to assess the ischemic burden. The Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT Coronary Angiography With Invasive Coronary Angiography (PACIFIC) study is a prospective controlled clinical single-center study conducted from January 23, 2012, to October 25, 2014, at the VU University Medical Center, Amsterdam, the Netherlands (NCT01521468). The contrast medium is visible on the angiograms, showing the blood vessels the fluid travels through. et al; CE-MARC 2 Investigators. The percentage of the myocardium that is ischemic was calculated by subtracting the resting total perfusion defect from the stress total perfusion defect. Corresponding Author: Paul Knaapen, MD, PhD, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands (p.knaapen@vumc.nl). Hybrid images were interpreted as follows. Author Contributions: Drs Danad and Knaapen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Interpretations by core laboratories were performed in a blinded fashion for CCTA (St Paul’s Hospital, Vancouver, British Columbia, Canada, and the Dalio Institute of Cardiovascular Imaging, New York–Presbyterian Hospital, New York), SPECT (Royal Brompton Hospital, London, England), and PET (Turku University Hospital, Turku, Finland) to ensure an unbiased grading of the scans. Does rubidium-82 PET have superior accuracy to SPECT perfusion imaging for the diagnosis of obstructive coronary disease? On the other hand, hybrid imaging significantly improved PPV when compared with CCTA alone (SPECT/CCTA, 94%; P = .001; PET/CCTA, 88%; P < .001). Fihn eTable 2 in the Supplement shows the angiographic findings and the prevalence of ischemia by FFR. Diagnostic accuracy of stress myocardial perfusion imaging compared to invasive coronary angiography with fractional flow reserve meta-analysis. O, Bengel M, RA, Wells Cardiac catheterisation and coronary angiography are usually very safe. However, future studies are needed to determine whether hybrid CT imaging for patients at the lower spectrum of pretest probability of CAD, relying primarily on the high sensitivity and NPV of noninvasive testing, will improve accuracy and clinical decision making. Underestimation of extent of ischemia by gated SPECT myocardial perfusion imaging in patients with left main coronary artery disease. The PPV and NPV at the level of the individual patient were compared using the marginal regression approach as proposed by Leisenring et al.10 Secondary analyses concerned vessel-specific analyses (eAppendix in the Supplement). Acquisition, analysis, or interpretation of data: Danad, Raijmakers, Driessen, Leipsic, Raju, Naoum, Knuuti, Mäki, Underwood, Min, Elmore, Stuijfzand, van Royen, Somsen, Huisman, van Lingen, Heymans, van de Ven, van Kuijk, van Rossum, Knaapen. The main risks of coronary angiography include: Coronary computed tomography angiography yielded a false-negative result for 9 patients, while 46 patients were falsely identified as having nonhemodynamically significant CAD from hybrid SPECT/CCTA and 23 were falsely identified as having nonhemodynamically significant CAD from hybrid PET/CCTA. et al. Danad U, Achenbach Diagnostic accuracy was highest for PET (85%; 95% CI, 80%-90%) compared with that of CCTA (74%; 95% CI, 67%-79%; P = .003) and SPECT (77%; 95% CI, 71%-83%; P = .02). 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. It usually involves taking X-rays of the heart's arteries (coronary arteries) using a technique called coronary angiography or arteriography. Danad et al. However, to date, prospective head-to-head studies are lacking regarding the diagnostic accuracy of these imaging modalities. Danad I, Raijmakers PG, Driessen RS, et al. E, Saraste They were also more likely to receive a diagnosis of … Effect of care guided by cardiovascular magnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates: the CE-MARC 2 randomized clinical trial. et al. PA. Cardiac hybrid imaging. Non-invasive 16-row multislice CT coronary angiography: usefulness of saline chaser. Takx Neglia The baseline characteristics of the patients are listed in Table 1, and imaging examples are given in eFigure 2 in the Supplement. The imaging provides a clear view of bones, soft tissues, and blood vessels at the same time. Clinical validation of SPECT attenuation correction using x-ray computed tomography–derived attenuation maps: multicenter clinical trial with angiographic correlation. Leisenring Association Between Noninvasive Cardiac Imaging and Diameter Stenosis as Assessed by Quantitative Coronary Angiography, eTable 1. B, Fearon Detailed Inclusion and Exclusion Criteria, eTable 2. [Article in Portuguese] Macieira-Coelho E(1), Carvalho M, Dionísio I, Prudêncio A, da Cunha JA, Cantinho G. R. New technology for noninvasive evaluation of coronary artery disease. Baseline Patient Characteristics, Table 2. C, eFigure 2. In … Coronary computed tomography angiography allows for the assessment of the severity of coronary stenosis, SPECT for the assessment of myocardial perfusion, and PET for absolute myocardial blood flow.1 Furthermore, hybrid techniques that allow for the fusion of SPECT and CCTA or PET and CCTA imaging have been recently reported.2-4, For measures of hemodynamically significant CAD, prior prospective multicenter randomized clinical trials have established invasive fractional flow reserve (FFR) to be a prognostic criterion standard, guiding decisions of revascularization resulting in improved event-free survival vs that seen with stenosis-guided revascularization.5-7 To our knowledge, a systematic comparison of the diagnostic performances of SPECT, PET, CCTA, and hybrid imaging using invasive FFR as a reference standard has not been performed. An array of noninvasive tests is available for the diagnosis of coronary artery disease (CAD), including coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), and positron emission tomography (PET). Montalescot The treatment of patients who are comatose after out-of-hospital cardiac arrest involves a complex, multidisciplinary approach that includes the use … A well-known limitation of SPECT, an imaging method dependent on relative rather than absolute perfusion assessment, is the presence of a normal study in the case of “balanced” ischemia observed in 3-vessel disease or left main disease. The effect of different definitions of significant CAD, conceptualized as either the degree of luminal narrowing by ICA or the impairment in coronary flow reflected by FFR, on the evaluation of CCTA in diagnostic accuracy studies can be extracted from prior studies.16,17, For measures of myocardial perfusion abnormalities, our results showed a higher diagnostic accuracy of PET vs SPECT MPI, as compared with FFR. However, CCTA is particularly hampered by the lack of functional information, resulting in overestimation of the significance of CAD when compared against FFR. Terms of Use| Hemodynamically significant lesions were present in the left anterior descending artery in 81 patients (38.9%), in the right coronary artery in 39 patients (18.8%), and in the circumflex artery in 38 patients (18.3%).
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